For the first time since its creation in 2004, the taxing authority that oversees health care for needy Travis County residents is trying to fundamentally change who would be eligible for free or low-cost services.

In redesigning the health care system for uninsured and underinsured county residents, Central Health officials are discussing how to categorize patients based on medical need, while potentially raising the income threshold for services. The Central Health board this spring discussed boosting the threshold from its current maximum of $48,500 for a family of four to nearly $91,000.

That idea went over with a thud, but it’s not entirely off the table. Central Health staff is exploring options and the impact on taxpayers.

A fleshed-out proposal is expected in November, but the discussion is underway now because of an unusual partnership between the public Central Health and the private Seton Healthcare Family. The two created the nonprofit Community Care Collaborative in 2013 to produce a better coordinated, more integrated care delivery system for the safety net population they serve. And now they are trying to put that system in place as their answer to fixing a fragmented, inefficient network of care.

It comes at a time of uncertainty about how much federal aid will be available for indigent health care after Sept. 30, 2016. That’s the expiration date of a Medicaid program that is expected to generate nearly $260 million in the new fiscal year for Travis County safety net providers — unless the federal government renews it.

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Seton is investing in the collaborative and building a $295 million teaching hospital that it will own where indigent patients will receive care. A legal agreement between Central Health and Seton allows Seton to retain $20 million a year for five years, a total of $100 million, to cover the costs of transitioning to the integrated delivery system, including hiring staff, setting up a call center, creating electronic records and other work, said Seton executive Greg Hartman, vice chairman of the collaborative.

Some observers have questioned whether Central Health is going too far to appease Seton, which has the right, under the legal agreement, to mutually decide with Central Health who should be eligible for taxpayer-subsidized health care services.

Bottom Line: Central Health's latest boondoggle is business as usual for an organization that has previously subsidized the murder of children and the second wealthiest University in the country; kudos to Jay Wiley for his willingness to shut the whole mess down.